Patients with COPD often have multiple chronic diseases and need complex care, wich we want to optimize. In primary care we compose a cohort of 150 patients with COPD and comorbidity wich we sescribe by biomedical variables and validated instrumentes for functioning and disability. Wich variables correlate with need of care? Can a prospective cohort study define prognostic markers for mortality, growing morbidity and loss of independence?